Psychological and Neuropsychological Testing in Medicare

I’ve previously reported here about provision of psychotherapy to the Medicare population. Another valuable service psychologists and other health professionals provide to those with Medicare is diagnostic psychological and neuropsychological testing. These assessment methods can help clarify diagnoses, formulate treatment plans, measure recovery or progress of conditions, and effects of treatment. To what extent are these being provided to Medicare beneficiaries? CMS’s “provider utilization” data can provide some answers.

Analyses of the utilization data from 2013 through 2015 show that Medicare beneficiaries were provided slightly less than 200,000 hours of psychological testing in 2015. (These analyses are for testing performed “by psychologist or physician,” and do not include technician- or computer-administered testing.) This was decreased by about 9% from the peak among these years of about 215,000 hours, in 2013. In contrast, nearly 600,000 hours of neuropsychological testing were provided in 2015, within an increasing trend during these years, amounting to an increase of about 10% from 2012.

Clinical psychologists provided the bulk of both psychological and neuropsychological testing. From 2012 through 2015, clinical psychologists provided 94.7% of all doctorally-performed neuropsychological testing, and 87% of all doctorally-provided psychological testing.

Estimated total expenditures for psychological testing in Medicare decreased by 12% from 2012. Estimated expenditures for neuropsychological testing increased by 46.4% from 2012 to 2015.

The estimated increase in expenditures for neuropsychological testing is largely attributable to the 8% jump in reimbursement for this procedure from 2013 to 2014.

The number of clinical psychologists performing neuropsychological testing increased by 10% from 2012 to 2015, from 1525 billing for this service in 2012, to 1681 in 2015. In contrast, the number of clinical psychologists billing for psychological testing showed just a 2.7% increase in the number providing this service from 2012 to 2015.

There were 55.6 million Medicare entrollees in 2015. With 1681 psychologists providing almost 95% of the neuropsychological testing to the Medicare population, this amounts to about 3 clinical psychologists per 100K entrollees providing this service. Contrast this to 25 clinical psychologists overall per 100K enrollees providing services.

The CMS data show that 136,583 Medicare beneficiaries received neuropsychological testing in 2015, well under 1% of the Medicare population. Given the likely prevalence of known or suspected dementia and other brain-related conditions in the Medicare population, enrollees may have substantially limited access to such assessment. Growth in the number of psychologists providing neuropsychological testing is encouraging, but the relatively limited numbers suggests a useful area for professional and workforce development, as well as education to Medicare enrollees and health care professionals about the benefits of undergoing and referring for this inexpensive and non-invasive diagnostic procedure.